Clerkship Course Description

To apply for an externship position, please log onto the Visiting Students Application Service (VSAS) and complete this online form (Form). If your school does not participate in VSAS, unfortunately we are unable to accommodate you at this time.

Please do not hesitate to contact the Clerkship Directors Dr. Rivera(ronaldr3@hs.uci.edu) and Dr. Matonis(dmatonis@hs.uci.edu), at any time for possible openings due to cancellations. Please note that between May and October, we generally only accept students who are planning to apply to our emergency medicine residency program. 

• Apply to the UC Irvine School of Medicine's Student Affairs office using the AAMC's VSAS. 
• Students who wish to rotate between May and October are required to enter your information using this form with the following information:
  • Your top three preferred start dates (in order of preference). 
  • Your curriculum vitae, including your USMLE Step 1 score and Core Clerkship grades.
  • The letter of intent to rotate at UCI ED.
  • The name and email address of your EM faculty advisor/mentor, or a faculty mentor who knows your career choice and can verify your goals and plans.

Students learn to conduct thorough but directed histories and physicals, as well as to formulate a plan for workup and care of each patient they see.

Procedural skills, such as suturing, paracentesis etc., are taught and supervised on a case-by-case basis as needed, depending on the patient’s complaints and need for evaluation.

All students are expected to introduce themselves as student physicians and to conduct themselves in a professional manner. These expectations are set out at student orientation.

By the fourth year of school, students already should be meeting these expectations. Students interact one-on-one with residents and faculty members who monitor their progress during each shift.

• Take a directed patient history and perform a complete physical examination
• Formulate plan of workup and treatment
• Present cases directly to the senior resident and attending physicians
• Learn techniques to improve procedural skills
• Follow patients from initial exam through discharge from the emergency department

Competencies:

• The ability to competently conduct a medical interview and counseling to take into account patient health beliefs, patient agenda and the need for comprehensive medical and psychosocial assessment
• The ability to competently perform a complete and organ-system-specific examination including a mental health status examination
• The ability to articulate a cogent, accurate assessment and plan, and problem list, using diagnostic clinical reasoning skills in all the major disciplines
• The ability to search the medical literature, including electronic databases, and to locate and interpret up-to-date evidence to optimize patient care
• The ability to practice effective preventive medicine by identifying, addressing and advocating for strategies to maintain health and wellbeing, to identify and treat disease early where appropriate and to advise on lifestyle practices
• The ability to function effectively within the context of complexity and uncertainty in medical care

Attitudes and commitments:

• Honesty and integrity reflecting the standards of the profession, in interacting with all colleagues, patients, families and professional organizations
• Professional behaviors reflecting compassion and respect for patient privacy, altruism and a commitment to comprehensive, holistic medical care
• Sensitivity and awareness of diverse cultures, health beliefs and social factors impacting patient health and illness
• The commitment to seek knowledge and skills to better serve the needs of the underserved in their communities

Content Theme Integration

Educational Activities

Students will be scheduled to work with a specific attending each shift. Given that it is the Emergency Department, you should plan to work a mix of days, nights, and weekend shifts (including holidays). If you need to be off for specific days during the rotation, you should not schedule your emergency medicine rotation during that time. Please note that vouchers for days off are not valid for EM rotations.

Approximately 2 weeks before the start of rotation, clerkship students receive an email from the clerkship coordinator detailing their rotation. The schedule will be made approximately 1-2 weeks in advance by Dr. Sakaria or Dr. Sudario. All students will be assigned a fairly equal distribution of day, swing, and night shifts. 547 students will complete 8 clinical shifts, and 630D students will complete 16 clinical shifts.

Shift swaps are allowed if both parties approve, it does not violate duty hours, and meets all other requirements detailed in the scheduling email. The swap request must be e-mailed to Dr. Sakaria and Dr. Sudario at least two days in advance and is subject to approval. 

If a conflict occurs midway through a scheduled rotation, shifts can be swapped with another student, but the change must be made on the schedule. The attendings have access to this schedule and expect students to adhere to this.

If you miss a shift for medical reasons please call the attending physician on duty at 714-456-5705,in addition to emailing the clerkship coordinator and director regarding your absence. All absences will be documented, and grades will be submitted as incomplete until the absence is made up. 

This is a sub-I rotation, wherein students are enrolled because they have expressed a strong interest in Emergency Medicine or have already decided that they are applying for residency in EM. The schedule is designed to specifically pair them with program leadership or clerkship leadership for as many shifts as possible. For the remaining shifts, we try to pair students as much as possible with faculty who are heavily involved in medical student or resident education. 

Clerkship students are expected to familiarize themselves with the CANVAS website, orientation packet and course syllabus. Orientation is held on the first Monday of the rotation at 7:30 a.m., followed immediately after by Task Training and ED Orientation.

FIRST DAY [First Monday from 7:30 a.m.-12:00 p.m.]

A virtual orientation is held over Zoom from 7:30AM-8:00AM. This is followed by a simulation and procedure session at the UC Irvine Simulation Center located at 836 Health Sciences Road Irvine, CA 92697-4089.

FIRST SHIFT

Check your schedule and report to the attending physician in the Emergency Department. You can usually track them down in the Resident Workroom. If the attending on your schedule has swapped out, please join the new faculty attending on the same shift.

ON-SHIFT ACTIVITIES/WORKFLOW

Log into EPIC and find the next patient to be seen. Ask the attending if it is an appropriate patient for you to see before signing up for the patient. 

Students will work under the direct supervision of EM attendings. It is intended that the students participate actively in the evaluation and management of patient cases assuming more responsibility as their level of comfort and expertise develops. Students are not to be observers on this rotation. There are no minimum or maximum numbers of patients to be seen in a typical clinical shift. This should be determined by the student's ability, time, and their supervising physician.

If at any point, you identify an unstable patient, either from the board or at the bedside, immediately notify the senior resident (R3 or R2) or an attending.

Please introduce yourself to the patient as a fourth-year medical student. Always address your history and physical so that it is focused on the patient’s chief complaint. After completing the initial assessment of your patient, formulate a plan, and present the case to the attending. The presentation should take about 3-5 minutes. Once your attending approves the plan, you can inform the nurse assigned to the patient of this plan. Do not order tests or administer medications without first discussing the plan with the attending. Please pend orders in EPIC once you have presented the patient. If at any time, you feel that a patient is very sick, or you do not feel comfortable managing a patient, please let the senior resident (R3 or R2) or attending know right away. Remember to document the H&P in EPIC, and let the attending know you have started a note.

Reassess your patients periodically, and give updates on care frequently. Note any change in your patient's condition and inform your attending immediately. If you call any consultants, note the name of the consultant, their department, pager number and the time they were called. You are expected to consult other specialties when necessary or perform the hand-off of patients to the admitting team.

If a patient is to be discharged home, it is expected the sub-interns will prepare discharge instructions, re-evaluate patients prior to discharge and answer all questions and concerns of the patient

PATIENT SIGN-OUTS

Patient sign outs from the medical student go directly to the R3 or attending on shift and not to the incoming student.

ROLES AND RESPONSIBILITIES

Students are expected to attend/arrive on time to all mandatory activities: orientation, onsite orientation, task training, all assigned shifts, Wednesday conferences/SIM Sessions/MS SIM Sessions, Flipped Classrooms, and TBLs.

Students are expected to complete all assigned case logs, procedures logs, alternative tasks, evaluations, and department exercises.

Journal Club is usually held on the third Thursday of each month from 6 to 10 p.m. Attendance is encouraged for all students.

The location varies and is usually held at the house of an ED attending or resident. You are excused from your shift to attend Journal Club but must return to your shift as soon as it has ended.

If you are interested in attending please RSVP so the clerkship coordinator can prepare a packet of articles to read. You will need to have read the articles prior to attending Journal Club.

Resident Conference Wednesdays 8a - 12p

Simulation Sessions 1st and 3rd Monday 8a-12p

Grand Rounds Conference Schedule

All students are required to attend the weekly [Wednesday] conferences/SIM sessions held at one of the following locations (location depends on residency calendar and students will be notified each week where conference is held):

• Conference: City Tower - 3800 W Chapman Ave, Suite 3200, Orange, CA 92868
• Sim Center: Irvine Campus - Building 836 Simulation Center, Health Sciences Road, 2nd Floor
• Zoom